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Hickman LJ, Sowden-Carvalho SL, Fraser DS, Schuster BA, Rybicki AJ, Galea JM, Cook JL. Dopaminergic manipulations affect the modulation and meta-modulation of movement speed: Evidence from two pharmacological interventions. Behav Brain Res 2024; 474:115213. [PMID: 39182625 DOI: 10.1016/j.bbr.2024.115213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
A body of research implicates dopamine in the average speed of simple movements. However, naturalistic movements span a range of different shaped trajectories and rarely proceed at a single constant speed. Instead, speed is reduced when drawing "corners" compared to "straights" (i.e., speed modulation), and the extent of this slowing down is dependent upon the global shape of the movement trajectory (i.e., speed meta-modulation) - for example whether the shape is an ellipse or a rounded square. At present, it is not known how (or whether) dopaminergic function controls continuous changes in speed during movement execution. The current paper reports effects on these kinematic features of movement following two forms of dopamine manipulation: Study One highlights movement differences in individuals with PD both ON and OFF their dopaminergic medication (N = 32); Study Two highlights movement differences in individuals from the general population on haloperidol (a dopamine receptor blocker, or "antagonist") and placebo (N = 43). Evidence is presented implicating dopamine in speed, speed modulation and speed meta-modulation, whereby low dopamine conditions are associated with reductions in these variables. These findings move beyond vigour models implicating dopamine in average movement speed, and towards a conceptualisation that involves the modulation of speed as a function of contextual information.
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Affiliation(s)
- Lydia J Hickman
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom; MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, United Kingdom.
| | - Sophie L Sowden-Carvalho
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
| | - Dagmar S Fraser
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
| | - Bianca A Schuster
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom; Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Austria
| | - Alicia J Rybicki
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
| | - Joseph M Galea
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
| | - Jennifer L Cook
- Centre for Human Brain Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
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2
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Bollu T, Whitehead SC, Prasad N, Walker J, Shyamkumar N, Subramaniam R, Kardon B, Cohen I, Goldberg JH. Motor cortical inactivation impairs corrective submovements in mice performing a hold-still center-out reach task. J Neurophysiol 2024; 132:829-848. [PMID: 39081209 PMCID: PMC11427071 DOI: 10.1152/jn.00241.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
Holding still and aiming reaches to spatial targets may depend on distinct neural circuits. Using automated homecage training and a sensitive joystick, we trained freely moving mice to contact a joystick, hold their forelimb still, and then reach to rewarded target locations. Mice learned the task by initiating forelimb sequences with clearly resolved submillimeter-scale micromovements followed by millimeter-scale reaches to learned spatial targets. Hundreds of thousands of trajectories were decomposed into millions of kinematic submovements, while photoinhibition was used to test roles of motor cortical areas. Inactivation of both caudal and rostral forelimb areas preserved the ability to produce aimed reaches, but reduced reach speed. Inactivation specifically of contralateral caudal forelimb area (CFA) additionally impaired the ability to aim corrective submovements to remembered locations following target undershoots. Our findings show that motor cortical inactivations reduce the gain of forelimb movements but that inactivation specifically of contralateral CFA impairs corrective movements important for reaching a target location.NEW & NOTEWORTHY To test the role of different cortical areas in holding still and reaching to targets, this study combined home-cage training with optogenetic silencing as mice engaged in a learned center-out-reach task. Inactivation specifically of contralateral caudal forelimb area (CFA) impaired corrective movements necessary to reach spatial targets to earn reward.
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Affiliation(s)
- Tejapratap Bollu
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
| | - Samuel C Whitehead
- Department of Physics, Cornell University, Ithaca, New York, United States
| | - Nikil Prasad
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
| | - Jackson Walker
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
| | - Nitin Shyamkumar
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
| | - Raghav Subramaniam
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
| | - Brian Kardon
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
| | - Itai Cohen
- Department of Physics, Cornell University, Ithaca, New York, United States
| | - Jesse H Goldberg
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, United States
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3
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Kroger C, Kagerer FA, McAuley JD. Interdependence of movement amplitude and tempo during self-paced finger tapping: evaluation of a preferred velocity hypothesis. Exp Brain Res 2024; 242:1025-1036. [PMID: 38451320 DOI: 10.1007/s00221-024-06814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
This study examined the relation between movement amplitude and tempo during self-paced rhythmic finger tapping to test a preferred velocity account of the preferred tempo construct. Preferred tempo refers to the concept that individuals have preferences for the pace of actions or events in their environment (e.g., the desired pace of walking or tempo of music). The preferred velocity hypothesis proposes that assessments of preferred tempo do not represent a pure time preference independent of spatial movement characteristics, but rather reflects a preference for an average movement velocity, predicting that preferred tempo will depend on movement amplitude. We tested this by having participants first perform a novel spontaneous motor amplitude (SMA) task in which they repetitively tapped their finger at their preferred amplitude without instructions about tapping tempo. Next, participants completed the spontaneous motor tempo (SMT) task in which they tapped their finger at their preferred tempo without instructions about tapping amplitude. Finally, participants completed a target amplitude version of the SMT task where they tapped at their preferred tempo at three target amplitudes (low, medium, and high). Participants (1) produced similar amplitudes and tempi regardless of instructions to produce either their preferred amplitude or preferred tempo, maintaining the same average movement velocity across SMA and SMT tasks and (2) altered their preferred tempo for different target amplitudes in the direction predicted by their estimated preferred velocity from the SMA and SMT tasks. Overall, results show the interdependence of movement amplitude and tempo in tapping assessments of preferred tempo.
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Affiliation(s)
- Carolyn Kroger
- Department of Psychology, Michigan State University, East Lansing, USA.
- Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Florian A Kagerer
- Department of Kinesiology, Michigan State University, East Lansing, USA
- Neuroscience Program, Michigan State University, East Lansing, USA
| | - J Devin McAuley
- Department of Psychology, Michigan State University, East Lansing, USA
- Neuroscience Program, Michigan State University, East Lansing, USA
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Latimer N, Reelfs A, Halbert J, Hansen J, Miller A, Barton C, Stuhr J, Zaman A, Stegemöller EL. The effects of auditory cues and weighted pens on handwriting in individuals with Parkinson's disease. J Hand Ther 2024; 37:144-152. [PMID: 37778882 DOI: 10.1016/j.jht.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Micrographia, or small handwriting, is a common symptom of Parkinson's disease (PD). Weighted pens have previously been recommended to improve handwriting, but there is limited research supporting their effectiveness. Additionally, previous research has demonstrated that music as an auditory cue can reduce variability in fine motor movements, but its effect on handwriting in people with PD remains unknown. PURPOSE This study explored potential handwriting interventions for people with PD by evaluating the effectiveness of weighted pens and auditory cues on handwriting. STUDY DESIGN This was a pilot cohort study. METHODS Eight older adults with PD used a standard pen and a weighted pen to write continuous cursive "l"s on 1.5-cm-lined paper for a total of 10 seconds while listening to auditory cues in 4 conditions: control (silence), metronome, activating music, and relaxing music. Kinematic data were measured with sensors attached to the tip of each pen, and muscle activity was measured with electromyography sensors adhered to the extensor digitorum communis and first dorsal interosseous. RESULTS When writing with the standard pen, peak-to-peak time was reduced in the metronome (control = 0.807 ± 0.121 seconds, metronome = 0.701 ± 0.100 seconds, p = 0.024) and activating (control = 0.807 ± 0.121 seconds, activating = 0.691 ± 0.113 seconds, p = 0.009) conditions compared to the control condition. Furthermore, the weighted pen increased the variability of distance between letter peaks (standard = 0.187 ± 0.010, weighted = 0.482 ± 0.065, p = 0.033) and the variability of time needed to complete each letter (standard = 0.176 ± 0.010, weighted = 0.187 ± 0.016, p = 0.042) compared to the standard pen. Finally, area under the curve of the extensor digitorum communis was reduced in the metronome (metronome = 66.03 ± 25.74 mV, control = 88.98 ± 30.40 mV, p = 0.034) and activating music (activating = 66.49 ± 26.02 mV, control = 88.98 ± 30.40 mV, p = 0.012) conditions compared to control when writing with the standard pen. CONCLUSIONS These results suggest that weighted pens may not improve handwriting in novice users, but auditory cues appear beneficial. This can inform future directions in the research and clinical application of handwriting interventions for persons with PD.
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Affiliation(s)
- Nicole Latimer
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Anna Reelfs
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Jamie Halbert
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Julia Hansen
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Ashley Miller
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Chloe Barton
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Jamie Stuhr
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Andrew Zaman
- Department of Kinesiology, Iowa State University, Ames, IA, USA
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Fröhlich H, Bontridder N, Petrovska-Delacréta D, Glaab E, Kluge F, Yacoubi ME, Marín Valero M, Corvol JC, Eskofier B, Van Gyseghem JM, Lehericy S, Winkler J, Klucken J. Leveraging the Potential of Digital Technology for Better Individualized Treatment of Parkinson's Disease. Front Neurol 2022; 13:788427. [PMID: 35295840 PMCID: PMC8918525 DOI: 10.3389/fneur.2022.788427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 12/18/2022] Open
Abstract
Recent years have witnessed a strongly increasing interest in digital technology within medicine (sensor devices, specific smartphone apps) and specifically also neurology. Quantitative measures derived from digital technology could provide Digital Biomarkers (DMs) enabling a quantitative and continuous monitoring of disease symptoms, also outside clinics. This includes the possibility to continuously and sensitively monitor the response to treatment, hence opening the opportunity to adapt medication pathways quickly. In addition, DMs may in the future allow early diagnosis, stratification of patient subgroups and prediction of clinical outcomes. Thus, DMs could complement or in certain cases even replace classical examiner-based outcome measures and molecular biomarkers measured in cerebral spinal fluid, blood, urine, saliva, or other body liquids. Altogether, DMs could play a prominent role in the emerging field of precision medicine. However, realizing this vision requires dedicated research. First, advanced data analytical methods need to be developed and applied, which extract candidate DMs from raw signals. Second, these candidate DMs need to be validated by (a) showing their correlation to established clinical outcome measures, and (b) demonstrating their diagnostic and/or prognostic value compared to established biomarkers. These points again require the use of advanced data analytical methods, including machine learning. In addition, the arising ethical, legal and social questions associated with the collection and processing of sensitive patient data and the use of machine learning methods to analyze these data for better individualized treatment of the disease, must be considered thoroughly. Using Parkinson's Disease (PD) as a prime example of a complex multifactorial disorder, the purpose of this article is to critically review the current state of research regarding the use of DMs, discuss open challenges and highlight emerging new directions.
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Affiliation(s)
- Holger Fröhlich
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing, Sankt Augustin, Germany
- Bonn-Aachen International Center for IT (b-it), University of Bonn, Bonn, Germany
| | - Noémi Bontridder
- Centre de Recherches Information, Droit et Societe, University of Namur, Namur, Belgium
| | | | - Enrico Glaab
- Luxembourg Center for Systems Medicine, University of Luxembourg, Esch, Luxembourg
| | - Felix Kluge
- Department of Artificial Intelligence in Biomedical Engineering, University of Erlangen Nuremberg, Erlangen, Germany
| | | | | | | | - Bjoern Eskofier
- Department of Artificial Intelligence in Biomedical Engineering, University of Erlangen Nuremberg, Erlangen, Germany
| | | | | | - Jürgen Winkler
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Jochen Klucken
- Luxembourg Center for Systems Medicine, University of Luxembourg, Esch, Luxembourg
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6
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Fasano A, Mazzoni A, Falotico E. Reaching and Grasping Movements in Parkinson's Disease: A Review. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1083-1113. [PMID: 35253780 PMCID: PMC9198782 DOI: 10.3233/jpd-213082] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Parkinson's disease (PD) is known to affect the brain motor circuits involving the basal ganglia (BG) and to induce, among other signs, general slowness and paucity of movements. In upper limb movements, PD patients show a systematic prolongation of movement duration while maintaining a sufficient level of endpoint accuracy. PD appears to cause impairments not only in movement execution, but also in movement initiation and planning, as revealed by abnormal preparatory activity of motor-related brain areas. Grasping movement is affected as well, particularly in the coordination of the hand aperture with the transport phase. In the last fifty years, numerous behavioral studies attempted to clarify the mechanisms underlying these anomalies, speculating on the plausible role that the BG-thalamo-cortical circuitry may play in normal and pathological motor control. Still, many questions remain open, especially concerning the management of the speed-accuracy tradeoff and the online feedback control. In this review, we summarize the literature results on reaching and grasping in parkinsonian patients. We analyze the relevant hypotheses on the origins of dysfunction, by focusing on the motor control aspects involved in the different movement phases and the corresponding role played by the BG. We conclude with an insight into the innovative stimulation techniques and computational models recently proposed, which might be helpful in further clarifying the mechanisms through which PD affects reaching and grasping movements.
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Affiliation(s)
- Alessio Fasano
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
- Correspondence to: Alessio Fasano and Egidio Falotico, The BioRobotics Institute, Scuola Superiore Sant’Anna, Polo Sant’Anna Valdera, Viale Rinaldo Piaggio, 34, 56025 Pontedera (PI), Italy. Tel.: +39 050 883 457; E-mails: and
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Egidio Falotico
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
- Correspondence to: Alessio Fasano and Egidio Falotico, The BioRobotics Institute, Scuola Superiore Sant’Anna, Polo Sant’Anna Valdera, Viale Rinaldo Piaggio, 34, 56025 Pontedera (PI), Italy. Tel.: +39 050 883 457; E-mails: and
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7
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Dehghanpur Deharab E, Ghaderyan P. Graphical representation and variability quantification of handwriting signals: New tools for Parkinson’s disease detection. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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8
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Petilli MA, Daini R, Saibene FL, Rabuffetti M. Automated scoring for a Tablet-based Rey Figure copy task differentiates constructional, organisational, and motor abilities. Sci Rep 2021; 11:14895. [PMID: 34290339 PMCID: PMC8295394 DOI: 10.1038/s41598-021-94247-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Accuracy in copying a figure is one of the most sensitive measures of visuo-constructional ability. However, drawing tasks also involve other cognitive and motor abilities, which may influence the final graphic produced. Nevertheless, these aspects are not taken into account in conventional scoring methodologies. In this study, we have implemented a novel Tablet-based assessment, acquiring data and information for the entire execution of the Rey Complex Figure copy task (T-RCF). This system extracts 12 indices capturing various dimensions of drawing abilities. We have also analysed the structure of relationships between these indices and provided insights into the constructs that they capture. 102 healthy adults completed the T-RCF. A subgroup of 35 participants also completed a paper-and-pencil drawing battery from which constructional, procedural, and motor measures were obtained. Principal component analysis of the T-RCF indices was performed, identifying spatial, procedural and kinematic components as distinct dimensions of drawing execution. Accordingly, a composite score for each dimension was determined. Correlational analyses provided indications of their validity by showing that spatial, procedural, and kinematic scores were associated with constructional, organisational and motor measures of drawing, respectively. Importantly, final copy accuracy was found to be associated with all of these aspects of drawing. In conclusion, copying complex figures entails an interplay of multiple functions. T-RCF provides a unique opportunity to analyse the entire drawing process and to extract scores for three critical dimensions of drawing execution.
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Affiliation(s)
- Marco A Petilli
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
| | - Roberta Daini
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
- NeuroMI-Milan Center for Neuroscience, Milan, Italy
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9
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Online Arabic and French handwriting of Parkinson’s disease: The impact of segmentation techniques on the classification results. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Schaffert N, Braun Janzen T, Ploigt R, Schlüter S, Vuong V, Thaut MH. Development and evaluation of a novel music-based therapeutic device for upper extremity movement training: A pre-clinical, single-arm trial. PLoS One 2020; 15:e0242552. [PMID: 33211773 PMCID: PMC7676671 DOI: 10.1371/journal.pone.0242552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Restoration of upper limb motor function and patient functional independence are crucial treatment targets in neurological rehabilitation. Growing evidence indicates that music-based intervention is a promising therapeutic approach for the restoration of upper extremity functional abilities in neurologic conditions such as cerebral palsy, stroke, and Parkinson's Disease. In this context, music technology may be particularly useful to increase the availability and accessibility of music-based therapy and assist therapists in the implementation and assessment of targeted therapeutic goals. In the present study, we conducted a pre-clinical, single-arm trial to evaluate a novel music-based therapeutic device (SONATA) for upper limb extremity movement training. The device consists of a graphical user interface generated by a single-board computer displayed on a 32" touchscreen with built-in speakers controlled wirelessly by a computer tablet. The system includes two operational modes that allow users to play musical melodies on a virtual keyboard or draw figures/shapes whereby every action input results in controllable sensory feedback. Four motor tasks involving hand/finger movement were performed with 21 healthy individuals (13 males, aged 26.4 ± 3.5 years) to evaluate the device's operational modes and main features. The results of the functional tests suggest that the device is a reliable system to present pre-defined sequences of audiovisual stimuli and shapes and to record response and movement data. This preliminary study also suggests that the device is feasible and adequate for use with healthy individuals. These findings open new avenues for future clinical research to further investigate the feasibility and usability of the SONATA as a tool for upper extremity motor function training in neurological rehabilitation. Directions for future clinical research are discussed.
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Affiliation(s)
- Nina Schaffert
- Department of Movement and Training Science, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
- BeSB GmbH Berlin, Sound Engineering, Berlin, Germany
| | - Thenille Braun Janzen
- Center for Mathematics, Computing and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
| | - Roy Ploigt
- BeSB GmbH Berlin, Sound Engineering, Berlin, Germany
| | | | - Veronica Vuong
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, Canada
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, Canada
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11
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Parziale A, Senatore R, Della Cioppa A, Marcelli A. Cartesian genetic programming for diagnosis of Parkinson disease through handwriting analysis: Performance vs. interpretability issues. Artif Intell Med 2020; 111:101984. [PMID: 33461684 DOI: 10.1016/j.artmed.2020.101984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
In the last decades, early disease identification through non-invasive and automatic methodologies has gathered increasing interest from the scientific community. Among others, Parkinson's disease (PD) has received special attention in that it is a severe and progressive neuro-degenerative disease. As a consequence, early diagnosis would provide more effective and prompt care strategies, that cloud successfully influence patients' life expectancy. However, the most performing systems implement the so called black-box approach, which do not provide explicit rules to reach a decision. This lack of interpretability, has hampered the acceptance of those systems by clinicians and their deployment on the field. In this context, we perform a thorough comparison of different machine learning (ML) techniques, whose classification results are characterized by different levels of interpretability. Such techniques were applied for automatically identify PD patients through the analysis of handwriting and drawing samples. Results analysis shows that white-box approaches, such as Cartesian Genetic Programming and Decision Tree, allow to reach a twofold goal: support the diagnosis of PD and obtain explicit classification models, on which only a subset of features (related to specific tasks) were identified and exploited for classification. Obtained classification models provide important insights for the design of non-invasive, inexpensive and easy to administer diagnostic protocols. Comparison of different ML approaches (in terms of both accuracy and interpretability) has been performed on the features extracted from the handwriting and drawing samples included in the publicly available PaHaW and NewHandPD datasets. The experimental findings show that the Cartesian Genetic Programming outperforms the white-box methods in accuracy and the black-box ones in interpretability.
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Affiliation(s)
- A Parziale
- Natural Computation Lab, DIEM, Università degli Studi di Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano (SA), Italy.
| | - R Senatore
- Natural Computation Lab, DIEM, Università degli Studi di Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano (SA), Italy.
| | - A Della Cioppa
- Natural Computation Lab, DIEM, Università degli Studi di Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano (SA), Italy; Institute for High-Performance Computing and Networking, National Research Council, Naples, Italy.
| | - A Marcelli
- Natural Computation Lab, DIEM, Università degli Studi di Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano (SA), Italy.
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12
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Gupta U, Bansal H, Joshi D. An improved sex-specific and age-dependent classification model for Parkinson's diagnosis using handwriting measurement. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105305. [PMID: 31935580 DOI: 10.1016/j.cmpb.2019.105305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/14/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Diagnosis of Parkinson's with higher accuracy is always desirable to slow down the progression of the disease and improved quality of life. There are evidences of inherent neurological differences between male and females as well as between elderly and adults. However, the potential of such gender and age infomration have not been exploited yet for Parkinson's identification. METHODS In this paper, we develop a sex-specific and age-dependent classification method to diagnose the Parkinson's disease using the online handwriting recorded from individuals with Parkinson's (n = 37; m/f-19/18;age-69.3 ± 10.9yrs) and healthy controls (n = 38; m/f-20/18;age-62.4 ± 11.3yrs). A support vector machine ranking method is used to present the features specific to their dominance in sex and age group for Parkinson's diagnosis. RESULTS The sex-specific and age-dependent classifier was observed significantly outperforming the generalized classifier. An improved accuracy of 83.75% (SD = 1.63) with the female-specific classifier, and 79.55% (SD = 1.58) with the old-age dependent classifier was observed in comparison to 75.76% (SD = 1.17) accuracy with the generalized classifier. CONCLUSIONS Combining the age and sex information proved to be encouraging in classification. A distinct set of features were observed to be dominating for higher classification accuracy in a different category of classification.
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Affiliation(s)
- Ujjwal Gupta
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauzkhas 110016, New Delhi, India.
| | - Hritik Bansal
- Department of Electrical Engineering, Indian Institute of Technology Delhi, Hauzkhas 110016, New Delhi, India.
| | - Deepak Joshi
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauzkhas 110016, New Delhi, India; Department of Biomedical Engineering, All India Institute of Medical Sciences, Delhi, India.
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13
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Ammour A, Aouraghe I, Khaissidi G, Mrabti M, Aboulem G, Belahsen F. A new semi-supervised approach for characterizing the Arabic on-line handwriting of Parkinson's disease patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 183:104979. [PMID: 31542687 DOI: 10.1016/j.cmpb.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2019] [Accepted: 07/06/2019] [Indexed: 06/10/2023]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease affecting significant portion of elderly population. One of the most frequent hallmarks and the first manifestation of PD is deterioration of handwriting. Since the diagnosis of Parkinson's disease is difficult, researchers have worked to develop a support tool based on algorithms to separate healthy controls from PD patients. On-line handwriting analysis is one of the methods that can be used to diagnose PD. In this study, we aimed to analyze the Arabic Handwriting of 28 Parkinson's disease patients and 28 healthy controls (HCs) who were the same age and have the same intellectual level. We focused on copying an Arabic text task. For each participant we have calculated 1482 features. Based on the most relevant features selected by the Pearson's coefficient correlation, the Hierarchical Ascendant Classification (HAC) was applied and generated 3 clusters of writers. The characterization of these clusters was carried out by using the quantitative and qualitative parameters. The obtained results show that the combination of these two aspects can discriminate at best PD patients from HCs.
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Dynamic Handwriting Analysis for Neurodegenerative Disease Assessment: A Literary Review. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9214666] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Studying the effects of neurodegeneration on handwriting has emerged as an interdisciplinary research topic and has attracted considerable interest from psychologists to neuroscientists and from physicians to computer scientists. The complexity of handwriting, in fact, appears to be sensitive to age-related impairments in cognitive functioning; thus, analyzing handwriting in elderly people may facilitate the diagnosis and monitoring of these impairments. A large body of knowledge has been collected in the last thirty years thanks to the advent of new technologies which allow researchers to investigate not only the static characteristics of handwriting but also especially the dynamic aspects of the handwriting process. The present paper aims at providing an overview of the most relevant literature investigating the application of dynamic handwriting analysis in neurodegenerative disease assessment. The focus, in particular, is on Parkinon’s disease (PD) and Alzheimer’s disease (AD), as the two most widespread neurodegenerative disorders. More specifically, the studies taken into account are grouped in accordance with three main research questions: disease insight, disease monitoring, and disease diagnosis. The net result is that dynamic handwriting analysis is a powerful, noninvasive, and low-cost tool for real-time diagnosis and follow-up of PD and AD. In conclusion of the paper, open issues still demanding further research are highlighted.
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Senatore R, Marcelli A. A paradigm for emulating the early learning stage of handwriting: Performance comparison between healthy controls and Parkinson’s disease patients in drawing loop shapes. Hum Mov Sci 2019; 65:S0167-9457(17)30834-5. [DOI: 10.1016/j.humov.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
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Broeder S, Heremans E, Pinto Pereira M, Nackaerts E, Meesen R, Verheyden G, Nieuwboer A. Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson’s disease? A pilot study. Hum Mov Sci 2019; 65:S0167-9457(17)30936-3. [DOI: 10.1016/j.humov.2018.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
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Abraham A, Wright GN, Morrison MW, Hart A, Dickstein R, Hackney ME. Psychometric properties of clock and pelvic drawings in Parkinson's disease: A validity and cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1781. [PMID: 31090203 DOI: 10.1002/pri.1781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is characterized by visuospatial and body schema deficits. People with PD often exhibit hypometric movements and graphic hypometria (i.e., small drawing dimensions). The goal of the current study was to explore graphic-metric representation in people with PD by assessing pelvic and clock drawing dimensions (i.e., height and width) and by investigating associations between pelvic drawing dimensions and participant characteristics. METHODS Twenty people (16 males, 4 females; M age: 65.75 ± 10.13 years) with idiopathic PD (Hoehn &Yahr Stages I-III) volunteered to participate in this study. Draw Your Pelvis and Clock Drawing tests were used for assessing drawing dimensions, which were then correlated with PD severity, stage and duration, cognitive level, side of symptoms onset, and pelvic schema score. Bivariate and multiple linear regression analyses were also used. RESULTS Excellent (.844-.999) interrater reliability was shown for measuring pelvic and clock drawing dimensions. Pelvic drawing dimensions did not significantly (P > .05) differ in magnitude, whereas clock drawing height was significantly (p < .01) greater than width, both suggesting graphic dysmetria (i.e., distorted graphic dimensions). Pelvic drawing width was negatively associated with PD severity and stage, was positively associated with pelvic schema score, and predicted all three parameters. CONCLUSION Measuring pelvic drawing dimensions, and specifically pelvic drawing width, holds potential as an adjunct diagnostic measure in PD assessments and for detecting pelvic schema deficits or misperceptions. This test can be used by physical therapists in the clinic for assessing disease severity, stage, and pelvic schema in people with PD. The knowledge gained from this study contributes to a greater understanding of graphic-metric representation and associated deficits in people with PD. Future studies should explore the relationship between pelvic drawing dimensions and pelvic mentally imaged estimates, and their role in motor planning, control, and execution in people with PD.
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Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Gene N Wright
- Science Illustration Program, Lamar Dodd School of Art, University of Georgia, Athens, GA, USA
| | - Margaret W Morrison
- Drawing and Painting Program, Lamar Dodd School of Art, University of Georgia, Athens, GA, USA
| | - Ariel Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Dickstein
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta Department of Veterans Affairs, Atlanta, GA, USA
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Automatic Diagnosis of Neurodegenerative Diseases: An Evolutionary Approach for Facing the Interpretability Problem. INFORMATION 2019. [DOI: 10.3390/info10010030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The use of Artificial Intelligence (AI) systems for automatic diagnoses is increasingly in the clinical field, being a useful support for the identification of several diseases. Nonetheless, the acceptance of AI-based diagnoses by the physicians is hampered by the black-box approach implemented by most performing systems, which do not clearly state the classification rules adopted. Methods: In this framework we propose a classification method based on a Cartesian Genetic Programming (CGP) approach, which allows for the automatic identification of the presence of the disease, and concurrently, provides the explicit classification model used by the system. Results: The proposed approach has been evaluated on the publicly available HandPD dataset, which contains handwriting samples drawn by Parkinson’s disease patients and healthy controls. We show that our approach compares favorably with state-of-the-art methods, and more importantly, allows the physician to identify an explicit model relevant for the diagnosis based on the most informative subset of features. Conclusion: The obtained results suggest that the proposed approach is particularly appealing in that, starting from the explicit model, it allows the physicians to derive a set of guidelines for defining novel testing protocols and intervention strategies.
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Abraham A, Hart A, Dickstein R, Hackney ME. "Will you draw me a pelvis?ˮ Dynamic neuro-cognitive imagery improves pelvic schema and graphic-metric representation in people with Parkinson's Disease: A randomized controlled trial. Complement Ther Med 2019; 43:28-35. [PMID: 30935544 DOI: 10.1016/j.ctim.2018.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Body schema (i.e., the mental representations of the body), vital for motor and cognitive functions, is often distorted in people with Parkinson's disease (PD). Deficits in body, and especially pelvic, schema can further exacerbate motor and cognitive deficits associated with PD. Such deficits, including those in graphic and metric misjudgments, can manifest in drawing tasks. Mental imagery is a recommended approach for PD rehabilitation with potential for ameliorating body schema. OBJECTIVE To investigate the effect of a two-week dynamic neuro-cognitive imagery (DNI) training versus in-home learning and exercise control (learning/exercise) on pelvic schema and graphic representation (i.e., drawing height and width). DESIGN Twenty participants with idiopathic PD (Hoehn&Yahr I-III; M age: 65.75 ± 10.13) were randomly allocated into either a DNI or a learning/exercise group. Participants were asked to complete the "Draw Your Pelvisˮ test in which they drew their pelvis at pre- and post-intervention. Drawings were assessed for pelvic schema score and drawing dimensions (i.e., height and weight). INTERVENTION DNI anatomical and metaphorical imagery focusing on pelvic anatomy and biomechanics. RESULTS No difference (p > .05) was detected at baseline between drawn pelvis height and width. Following intervention, improvements were greater in the DNI group for pelvic schema (p < .01), drawn pelvic width (p < .05) and width-height difference (p < .05). CONCLUSIONS This study suggests that DNI could serve as a rehabilitation path for improving body schema in people with PD. Future studies should explore DNI mechanisms of effect and the effect of enhanced pelvic schema on motor and non-motor deficits in this population.
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Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Kinesiology, University of Georgia, Athens, Georgia, USA.
| | - Ariel Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ruth Dickstein
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Atlanta Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia, USA
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Impedovo D, Pirlo G. Dynamic Handwriting Analysis for the Assessment of Neurodegenerative Diseases: A Pattern Recognition Perspective. IEEE Rev Biomed Eng 2019; 12:209-220. [DOI: 10.1109/rbme.2018.2840679] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Handwriting training in Parkinson's disease: A trade-off between size, speed and fluency. PLoS One 2017; 12:e0190223. [PMID: 29272301 PMCID: PMC5741263 DOI: 10.1371/journal.pone.0190223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In previous work, we found that intensive amplitude training successfully improved micrographia in Parkinson's disease (PD). Handwriting abnormalities in PD also express themselves in stroke duration and writing fluency. It is currently unknown whether training changes these dysgraphic features. OBJECTIVE To determine the differential effects of amplitude training on various hallmarks of handwriting abnormalities in PD. METHODS We randomized 38 right-handed subjects in early to mid-stage of PD into an experimental group (n = 18), receiving training focused at improving writing size during 30 minutes/day, five days/week for six weeks, and a placebo group (n = 20), receiving stretch and relaxation exercises at equal intensity. Writing skills were assessed using a touch-sensitive tablet pre- and post-training, and after a six-week retention period. Tests encompassed a transfer task, evaluating trained and untrained sequences, and an automatization task, comparing single- and dual-task handwriting. Outcome parameters were stroke duration (s), writing velocity (cm/s) and normalized jerk (i.e. fluency). RESULTS In contrast to the reported positive effects of training on writing size, the current results showed increases in stroke duration and normalized jerk after amplitude training, which were absent in the placebo group. These increases remained after the six-week retention period. In contrast, velocity remained unchanged throughout the study. CONCLUSION While intensive amplitude training is beneficial to improve writing size in PD, it comes at a cost as fluency and stroke duration deteriorated after training. The findings imply that PD patients can redistribute movement priorities after training within a compromised motor system.
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Thomas M, Lenka A, Kumar Pal P. Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions. Mov Disord Clin Pract 2017; 4:806-818. [PMID: 30363367 PMCID: PMC6174397 DOI: 10.1002/mdc3.12552] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD. METHODS The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases. RESULTS Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term PD dysgraphia. In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders. CONCLUSION The journey from micrographia to PD dysgraphia is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.
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Affiliation(s)
- Mathew Thomas
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Abhishek Lenka
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
- Department of Clinical NeurosciencesNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
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Kotsavasiloglou C, Kostikis N, Hristu-Varsakelis D, Arnaoutoglou M. Machine learning-based classification of simple drawing movements in Parkinson's disease. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.08.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Inzelberg R, Plotnik M, Harpaz NK, Flash T. Micrographia, much beyond the writer's hand. Parkinsonism Relat Disord 2016; 26:1-9. [PMID: 26997656 DOI: 10.1016/j.parkreldis.2016.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/12/2016] [Accepted: 03/06/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This review on micrographia aims to draw the clinician's attention to non-Parkinsonian etiologies, provide clues to differential diagnosis, and summarize current knowledge on the phenomenology, etiology, and mechanisms underlying micrographia. METHODS A systematic review of the existing literature was performed. RESULTS Micrographia, namely small sized handwriting has long been attributed to Parkinson's disease. However, it has often been observed as part of the clinical picture of additional neurodegenerative disorders, sometimes antedating the motor signs, or following focal basal ganglia lesions without any accompanying parkinsonism, suggesting that bradykinesia and rigidity are not sine-qua-non for the development of this phenomenon. Therefore, micrographia in a patient with no signs of parkinsonism may prompt the clinician to perform imaging in order to exclude a focal basal ganglia lesion. Dopaminergic etiology in this and other cases is doubtful, since levodopa ameliorates letter stroke size only partially, and only in some patients. Parkinsonian handwriting is often characterized by lack of fluency, slowness, and less frequently by micrographia. Deviations from kinematic laws of motion that govern normal movement, including the lack of movement smoothness and inability to scale movement amplitude to the desired size, may reflect impairments in motion planning, possible loss of automaticity and reduced movement vigor. CONCLUSIONS The etiology, neuroanatomy, mechanisms and models of micrographia are discussed. Dysfunction of the basal ganglia circuitry induced by neurodegeneration or disruption by focal damage give rise to micrographia.
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Affiliation(s)
- Rivka Inzelberg
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
| | - Meir Plotnik
- Department of Pharmacology and Physiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel.
| | - Naama Kadmon Harpaz
- Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
| | - Tamar Flash
- Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
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Drotár P, Mekyska J, Rektorová I, Masarová L, Smékal Z, Faundez-Zanuy M. Evaluation of handwriting kinematics and pressure for differential diagnosis of Parkinson's disease. Artif Intell Med 2016; 67:39-46. [PMID: 26874552 DOI: 10.1016/j.artmed.2016.01.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 12/30/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We present the PaHaW Parkinson's disease handwriting database, consisting of handwriting samples from Parkinson's disease (PD) patients and healthy controls. Our goal is to show that kinematic features and pressure features in handwriting can be used for the differential diagnosis of PD. METHODS AND MATERIAL The database contains records from 37 PD patients and 38 healthy controls performing eight different handwriting tasks. The tasks include drawing an Archimedean spiral, repetitively writing orthographically simple syllables and words, and writing of a sentence. In addition to the conventional kinematic features related to the dynamics of handwriting, we investigated new pressure features based on the pressure exerted on the writing surface. To discriminate between PD patients and healthy subjects, three different classifiers were compared: K-nearest neighbors (K-NN), ensemble AdaBoost classifier, and support vector machines (SVM). RESULTS For predicting PD based on kinematic and pressure features of handwriting, the best performing model was SVM with classification accuracy of Pacc=81.3% (sensitivity Psen=87.4% and specificity of Pspe=80.9%). When evaluated separately, pressure features proved to be relevant for PD diagnosis, yielding Pacc=82.5% compared to Pacc=75.4% using kinematic features. CONCLUSION Experimental results showed that an analysis of kinematic and pressure features during handwriting can help assess subtle characteristics of handwriting and discriminate between PD patients and healthy controls.
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Affiliation(s)
- Peter Drotár
- Department of Telecommunications, Brno University of Technology, Technická 12, 61200 Brno, Czech Republic
| | - Jiří Mekyska
- Department of Telecommunications, Brno University of Technology, Technická 12, 61200 Brno, Czech Republic
| | - Irena Rektorová
- First Department of Neurology, Faculty of Medicine, St. Anns University Hospital, Pekarska 664, 66591 Brno, Czech Republic.
| | - Lucia Masarová
- First Department of Neurology, Faculty of Medicine, St. Anns University Hospital, Pekarska 664, 66591 Brno, Czech Republic
| | - Zdeněk Smékal
- Department of Telecommunications, Brno University of Technology, Technická 12, 61200 Brno, Czech Republic
| | - Marcos Faundez-Zanuy
- Signal Processing Group, Tecnocampus, Escola Universitaria Politecnica de Mataro, Avda. Ernest Llunch 32, 08302 Mataro, Spain
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Zietsma RC, Borgemeester RWK, van Laar T, Maurits NM. Graphical Tasks to Measure Upper Limb Function in Patients With Parkinson's Disease: Validity and Response to Dopaminergic Medication. IEEE J Biomed Health Inform 2015; 21:283-289. [PMID: 26625435 DOI: 10.1109/jbhi.2015.2503802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The most widely used method to assess motor functioning in Parkinson's disease (PD) patients is the unified Parkinson's disease rating scale-III (UPDRS-III). The UPDRS-III has limited ability to detect subtle changes in motor symptoms. Alternatively, graphical tasks can be used to provide objective measures of upper limb motor dysfunction. This study investigated the validity of such graphical tasks to assess upper limb function in PD patients and their ability to detect subtle changes in performance. Fourteen PD patients performed graphical tasks before and after taking dopaminergic medication. Graphical tasks included figure tracing, writing, and a modified Fitts' task. The Purdue pegboard test was performed to validate these graphical tasks. Movement time (MT), writing size, and the presence of tremor were assessed. MT on the graphical tasks correlated significantly with performance on the Purdue pegboard test (Spearman's ρ > 0.65; p < 0.05). MT decreased significantly after the intake of dopaminergic medication. Tremor power decreased after taking dopaminergic medication in most PD patients who suffered from tremor. Writing size did not correlate with performance on the Purdue pegboard test, nor did it change after taking medication. Our set of graphical tasks is valid to assess upper limb function in PD patients. MT proved to be the most useful measure for this purpose. The response on dopaminergic medication was optimally reflected by an improved MT on the graphical tasks in combination with a decreased tremor power, whereas writing size did not respond to dopaminergic treatment.
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Wu T, Zhang J, Hallett M, Feng T, Hou Y, Chan P. Neural correlates underlying micrographia in Parkinson's disease. Brain 2015; 139:144-60. [PMID: 26525918 DOI: 10.1093/brain/awv319] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/16/2015] [Indexed: 11/14/2022] Open
Abstract
Micrographia is a common symptom in Parkinson's disease, which manifests as either a consistent or progressive reduction in the size of handwriting or both. Neural correlates underlying micrographia remain unclear. We used functional magnetic resonance imaging to investigate micrographia-related neural activity and connectivity modulations. In addition, the effect of attention and dopaminergic administration on micrographia was examined. We found that consistent micrographia was associated with decreased activity and connectivity in the basal ganglia motor circuit; while progressive micrographia was related to the dysfunction of basal ganglia motor circuit together with disconnections between the rostral supplementary motor area, rostral cingulate motor area and cerebellum. Attention significantly improved both consistent and progressive micrographia, accompanied by recruitment of anterior putamen and dorsolateral prefrontal cortex. Levodopa improved consistent micrographia accompanied by increased activity and connectivity in the basal ganglia motor circuit, but had no effect on progressive micrographia. Our findings suggest that consistent micrographia is related to dysfunction of the basal ganglia motor circuit; while dysfunction of the basal ganglia motor circuit and disconnection between the rostral supplementary motor area, rostral cingulate motor area and cerebellum likely contributes to progressive micrographia. Attention improves both types of micrographia by recruiting additional brain networks. Levodopa improves consistent micrographia by restoring the function of the basal ganglia motor circuit, but does not improve progressive micrographia, probably because of failure to repair the disconnected networks.
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Affiliation(s)
- Tao Wu
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
| | - Jiarong Zhang
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
| | - Mark Hallett
- 3 Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tao Feng
- 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China 4 China National Clinical Research Centre for Neurological Diseases, Beijing, China 5 Department of Neurology, Centre for Neurodegenerative Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanan Hou
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
| | - Piu Chan
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
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Summa S, Basteris A, Betti E, Sanguineti V. Adaptive training with full-body movements to reduce bradykinesia in persons with Parkinson's disease: a pilot study. J Neuroeng Rehabil 2015; 12:16. [PMID: 25885094 PMCID: PMC4336500 DOI: 10.1186/s12984-015-0009-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/04/2015] [Indexed: 11/21/2022] Open
Abstract
Background Bradykinesia (slow movements) is a common symptom of Parkinson’s disease (PD) and results in reduced mobility and postural instability. The objective of this study is to develop and demonstrate a technology-assisted exercise protocol that is specifically aimed at reducing bradykinesia. Methods Seven persons with PD participated in this study. They were required to perform whole body reaching movements toward targets placed in different directions and at different elevations. Movements were recorded by a Microsoft Kinect movement sensor and used to control a human-like avatar, which was continuously displayed on a screen placed in front of the subjects. After completion of each movement, subjects received a 0-100 score that was inversely proportional to movement time. Target distance in the next movements was automatically adjusted in order to keep the score around a pre-specified target value. In this way, subjects always exercised with the largest movement amplitude they could sustain. The training protocol was organised into blocks of 45 movements toward targets placed in three different directions and at three different elevations (a total of nine targets). Each training session included a finite number of blocks, fitted within a fixed 40 minutes duration. The whole protocol included a total of 10 sessions (approximately two sessions/week). As primary outcome measure we took the absolute average acceleration. Various aspects of movement performance were taken as secondary outcome measures, namely accuracy (undershoot error), path curvature, movement time, and average speed. Results Throughout sessions, we observed an increase of the absolute average acceleration and speed and decreased undershoot error and movement time. Exercise also significantly affected the relationship between target elevation and both speed and acceleration - the improvement was greater at higher elevations. Conclusions The device and the protocol were well accepted by subjects and appeared safe and easy to use. Our preliminary results point at a training-induced reduction of bradykinesia.
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Affiliation(s)
- Susanna Summa
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy.
| | - Angelo Basteris
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy. .,School of Computer Science, University of Hertfordshire, Hatfield, UK.
| | - Enrico Betti
- Functional Recovery and Rehabilitation Service, Hospital 'La Colletta', Arenzano, Italy.
| | - Vittorio Sanguineti
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy.
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Drotár P, Mekyska J, Rektorová I, Masarová L, Smékal Z, Faundez-Zanuy M. Analysis of in-air movement in handwriting: A novel marker for Parkinson's disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 117:405-411. [PMID: 25261003 DOI: 10.1016/j.cmpb.2014.08.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/11/2014] [Accepted: 08/22/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Parkinson's disease (PD) is the second most common neurodegenerative disease affecting significant portion of elderly population. One of the most frequent hallmarks and usually also the first manifestation of PD is deterioration of handwriting characterized by micrographia and changes in kinematics of handwriting. There is no objective quantitative method of clinical diagnosis of PD. It is thought that PD can only be definitively diagnosed at postmortem, which further highlights the complexities of diagnosis. METHODS We exploit the fact that movement during handwriting of a text consists not only from the on-surface movements of the hand, but also from the in-air trajectories performed when the hand moves in the air from one stroke to the next. We used a digitizing tablet to assess both in-air and on-surface kinematic variables during handwriting of a sentence in 37 PD patients on medication and 38 age- and gender-matched healthy controls. RESULTS By applying feature selection algorithms and support vector machine learning methods to separate PD patients from healthy controls, we demonstrated that assessing the in-air/on-surface hand movements led to accurate classifications in 84% and 78% of subjects, respectively. Combining both modalities improved the accuracy by another 1% over the evaluation of in-air features alone and provided medically relevant diagnosis with 85.61% prediction accuracy. CONCLUSIONS Assessment of in-air movements during handwriting has a major impact on disease classification accuracy. This study confirms that handwriting can be used as a marker for PD and can be with advance used in decision support systems for differential diagnosis of PD.
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Affiliation(s)
- Peter Drotár
- Brno University of Technology, Technicka 12, Brno, Czech Republic
| | - Jiří Mekyska
- Brno University of Technology, Technicka 12, Brno, Czech Republic
| | - Irena Rektorová
- First Department of Neurology, Masaryk University and St. Anne's Hospital, Pekarska 664, 656 91 Brno, Czech Republic.
| | - Lucia Masarová
- First Department of Neurology, Masaryk University and St. Anne's Hospital, Pekarska 664, 656 91 Brno, Czech Republic
| | - Zdenek Smékal
- Brno University of Technology, Technicka 12, Brno, Czech Republic
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Whitfield JA, Goberman AM. Articulatory-acoustic vowel space: application to clear speech in individuals with Parkinson's disease. JOURNAL OF COMMUNICATION DISORDERS 2014; 51:19-28. [PMID: 25074511 DOI: 10.1016/j.jcomdis.2014.06.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/16/2014] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND/PURPOSE Individuals with Parkinson disease (PD) often exhibit decreased range of movement secondary to the disease process, which has been shown to affect articulatory movements. A number of investigations have failed to find statistically significant differences between control and disordered groups, and between speaking conditions, using traditional vowel space area measures. The purpose of the current investigation was to evaluate both between-group (PD versus control) and within-group (habitual versus clear) differences in articulatory function using a novel vowel space measure, the articulatory-acoustic vowel space (AAVS). METHODS The novel AAVS is calculated from continuously sampled formant trajectories of connected speech. In the current study, habitual and clear speech samples from twelve individuals with PD along with habitual control speech samples from ten neurologically healthy adults were collected and acoustically analyzed. In addition, a group of listeners completed perceptual rating of speech clarity for all samples. RESULTS Individuals with PD were perceived to exhibit decreased speech clarity compared to controls. Similarly, the novel AAVS measure was significantly lower in individuals with PD. In addition, the AAVS measure significantly tracked changes between the habitual and clear conditions that were confirmed by perceptual ratings. CONCLUSIONS In the current study, the novel AAVS measure is shown to be sensitive to disease-related group differences and within-person changes in articulatory function of individuals with PD. Additionally, these data confirm that individuals with PD can modulate the speech motor system to increase articulatory range of motion and speech clarity when given a simple prompt. LEARNING OUTCOMES The reader will be able to (i) describe articulatory behavior observed in the speech of individuals with Parkinson disease; (ii) describe traditional measures of vowel space area and how they relate to articulation; (iii) describe a novel measure of vowel space, the articulatory-acoustic vowel space and its relationship to articulation and the perception of speech clarity.
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Affiliation(s)
- Jason A Whitfield
- Department of Communication Sciences and Disorders, 200 Health and Human Services Building, Bowling Green State University, Bowling Green, OH 43403, USA.
| | - Alexander M Goberman
- Department of Communication Sciences and Disorders, 200 Health and Human Services Building, Bowling Green State University, Bowling Green, OH 43403, USA
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Letanneux A, Danna J, Velay JL, Viallet F, Pinto S. From micrographia to Parkinson's disease dysgraphia. Mov Disord 2014; 29:1467-75. [PMID: 25156696 DOI: 10.1002/mds.25990] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
Micrographia, an abnormal reduction in writing size, is a specific behavioral deficit associated with Parkinson's disease (PD). In recent years, the availability of graphic tablets has made it possible to study micrographia in unprecedented detail. Consequently, a growing number of studies show that PD patients also exhibit impaired handwriting kinematics. Is micrographia still the most characteristic feature of PD-related handwriting deficits? To answer this question, we identified studies that investigated handwriting in PD, either with conventional pencil-and-paper measures or with graphic tablets, and we reported their findings on key spatiotemporal and kinematic variables. We found that kinematic variables (velocity, fluency) differentiate better between control participants and PD patients, and between off- and on-treatment PD patients, than the traditional measure of static writing size. Although reduced writing size is an important feature of PD handwriting, the deficit is not restricted to micrographia stricto sensu. Therefore, we propose the term PD dysgraphia, which encompasses all deficits characteristic of Parkinsonian handwriting. We conclude that the computerized analysis of handwriting movements is a simple and useful tool that can contribute to both diagnosis and follow-up of PD.
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Affiliation(s)
- Alban Letanneux
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage, UMR 7309, Aix-en-Provence, France
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Conway BA, Zietsma RC, Leenders KL, Maurits NM. Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease. PLoS One 2014; 9:e97614. [PMID: 24854199 PMCID: PMC4031150 DOI: 10.1371/journal.pone.0097614] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting University Medical Center Groningen, tertiary care, the Netherlands. Participants Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions Not applicable. Main Outcome Measures Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.
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Affiliation(s)
- Esther J. Smits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | | | - Luc Cluitmans
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Bernard A. Conway
- The Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | | | - Klaus L. Leenders
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Broeder S, Nackaerts E, Nieuwboer A, Smits-Engelsman B, Swinnen S, Heremans E. The effects of dual tasking on handwriting in patients with Parkinson’s disease. Neuroscience 2014; 263:193-202. [DOI: 10.1016/j.neuroscience.2014.01.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/26/2022]
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Danna J, Paz-Villagrán V, Velay JL. Signal-to-noise velocity peaks difference: a new method for evaluating the handwriting movement fluency in children with dysgraphia. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4375-4384. [PMID: 24139714 DOI: 10.1016/j.ridd.2013.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/06/2013] [Accepted: 09/09/2013] [Indexed: 06/02/2023]
Abstract
This study evaluated handwriting movement dysfluency related to dysgraphia. A new variable, the Signal-to-Noise velocity peaks difference (SNvpd), was proposed to describe abnormal velocity fluctuations in cursive handwriting. This variable was compared to two variables most frequently used variables for assessing handwriting fluency. This comparison was carried out for three different groups, children with dysgraphia, proficient children, and adults, all of whom wrote the same single word. The adults were taken as the reference. Results revealed that, of the three variables studied, the SNvpd proved most efficient in discriminating children with dysgraphia, and that furthermore, it had the significant advantage of facilitating the localization of dysfluency peaks within a word. Our results also showed that the movement dysfluency of children with dysgraphia was specific to certain letters. In light of these results, we discuss the methodological and theoretical relevance of this new variable to the analysis of handwriting movement with the aim of characterizing dysgraphia.
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Affiliation(s)
- Jérémy Danna
- Laboratoire de Neurosciences Cognitives, UMR 7291, CNRS - Aix-Marseille Université, France; Brain and Language Research Institute, LPL, CNRS - Aix-Marseille Université, France.
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Kulkarni O, LaFaver K, Tarsy D. The “floating door sign” in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:825-6. [DOI: 10.1016/j.parkreldis.2013.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/10/2013] [Accepted: 04/20/2013] [Indexed: 10/26/2022]
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Nackaerts E, Vervoort G, Heremans E, Smits-Engelsman BC, Swinnen SP, Nieuwboer A. Relearning of writing skills in Parkinson's disease: A literature review on influential factors and optimal strategies. Neurosci Biobehav Rev 2013; 37:349-57. [DOI: 10.1016/j.neubiorev.2013.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/08/2012] [Accepted: 01/07/2013] [Indexed: 01/01/2023]
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The 9-hole PEG test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with Parkinson disease. J Neurol Phys Ther 2012; 35:157-63. [PMID: 22020457 DOI: 10.1097/npt.0b013e318235da08] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Pegboard tests of hand dexterity are commonly used in clinical settings to assess upper extremity function in various populations. For individuals with Parkinson disease (PD), the clinical utility of pegboard tests has not been fully evaluated. Our purpose was to examine the commercially available 9-Hole Peg Test (9HPT) using a large sample of individuals with PD to determine average values, test-retest reliability, and factors predictive of 9HPT performance. METHODS A total of 262 participants with PD (67% men, Hoehn & Yahr stage = 2.3 ± 0.7) completed the 9HPT along with a battery of other tests including the Movement Disorder Society Unified PD Rating Scale-Motor Subscale III and Freezing of Gait Questionnaire. RESULTS Average time to complete the 9HPT was 31.4 ± 15.7 s with the dominant and 32.2 ± 12.4 s with the nondominant hand. Test-retest reliability of 2 trials performed with the same hand was high (dominant ICC2,1 = 0.88, nondominant ICC2,1 = 0.91). Women performed the test significantly faster than men, and nonfreezers significantly faster than freezers. For either hand, age, bradykinesia, and freezing of gait scores individually predicted significant portions of the variance in 9HPT time. Sex also was a significant predictor, but for the nondominant hand only. Tremor and rigidity did not predict performance. DISCUSSION AND CONCLUSIONS The 9HPT appears to be a clinically useful measure for assessing upper extremity function in individuals with PD. The 9HPT has advantages over previously used methods including standardization, known normative values for healthy controls, commercial availability, transportability, and ease of administration.
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Dyskinetic Parkinson’s disease patients demonstrate motor abnormalities off medication. Exp Brain Res 2011; 214:471-9. [DOI: 10.1007/s00221-011-2845-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 08/14/2011] [Indexed: 10/17/2022]
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Song YG, Yoo KS, Park KW, Park JH. Coordinative and limb-specific control of bimanual movements in patients with Parkinson's disease and cerebellar degeneration. Neurosci Lett 2010; 482:146-50. [DOI: 10.1016/j.neulet.2010.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/05/2010] [Accepted: 07/09/2010] [Indexed: 10/19/2022]
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Albert F, Diermayr G, Diemayr G, McIsaac TL, Gordon AM. Coordination of grasping and walking in Parkinson's disease. Exp Brain Res 2010; 202:709-21. [PMID: 20143050 DOI: 10.1007/s00221-010-2179-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 01/22/2010] [Indexed: 11/25/2022]
Abstract
Studies on grasp control underlying manual dexterity in people with Parkinson disease (PD) suggest that anticipatory grasp control is mainly unaffected during discrete tasks using simple two-digit grasp. Nevertheless, impaired hand function during daily activities is one of the most disabling symptoms of PD. As many daily grasping activities occur during functional movements involving the whole body, impairments in anticipatory grasp control might emerge during a continuous dynamic task such as object transport during walking. In this case, grasp control must be coordinated along with multiple body segments. The present study investigated the effect of PD on anticipatory grasp control and intersegmental coordination during walking with a hand-held object. Nine individuals with idiopathic PD (tested OFF and ON medication) and nine healthy age-matched controls carried a grip instrument between their right thumb and index finger during self-paced and fast walking. Although the amplitude of grip forces was higher in standing and walking for subjects with PD, both subjects with PD and control subjects coupled grip and inertial force changes in an anticipatory fashion while walking. However, gait-induced motions of the object relative to that of the trunk (i.e., dampening) was reduced in subjects with PD. Medication increased the dampening in all subjects with PD. We suggest that these differences are associated with impairments in intersegmental coordination.
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Affiliation(s)
- Frederic Albert
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 199, New York, NY 10017, USA
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